低剂量CT灌注在中度重症高血脂性急性胰腺炎转归中的评价价值

目的  探讨低剂量CT灌注在中度重症高血脂性急性胰腺炎患者转归中临床意义。 方法  回顾性分析76例高血脂性胰腺炎患者CT灌注特点，其中中度重症（A组）54例，轻症（B组）22例。采用第三代西门子双源Force CT进行胰腺灌注扫描，将灌注图像传至工作站灌注软件包，对灌注参数血容量、血流量、流量提取乘积、平均通过时间、达峰时间、最大密度值进行组间比较，并分析实验室数据包括血淀粉酶、血脂肪酶、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血糖、载脂蛋白A1、载脂蛋白B及灌注参数与临床分级的相关性。 结果  和B组相比，A组的总胆固醇，甘油三酯、高密度脂蛋白、平均通过时间、TTD均升高，灌注参数血容量、血流量、最大密度值、流量提取乘积均表现为降低（P < 0.05），胰腺灌注参数(灌注参数血容量、血流量、最大密度值)与高血脂性胰腺炎严重程度呈负相关（r=-0.835、-0.753、-0.543，P < 0.05）。 结论  第三代双源低剂量CT灌注可以用于评价高血脂性胰腺炎患者胰腺微循环障碍的严重程度，有利于临床早期治疗、干预。

Value of low-dose CT perfusion in evaluation of prognosis in patients with moderately severe hyperglycemic acute pancreatitis

  Objective  To investigate the value of low-dose CT perfusion in the assessment of patients with moderately severe hyperglycemic acute pancreatitis.  Methods  Retrospective study was performed in 76 patients with hyperglycemic acute pancreatitis. Patients were dichotomized into two groups. Group A: 54 patients with moderately severe hyperglycemic acute pancreatitis.Group B: 22 patients with mild hyperglycemic acute pancreatitis. The perfusion images were acquired with the third-generation dual-source CT (DSCT) and analyzed with the pancreatic perfusion software package. We analyzed the laboratory data and perfusion parameters, including serum amylasemia (AMY), Lipase (LPS), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein(LDL), apoprotein A1(Apo-A1), apoprotein B (Apo-B) blood glucose (BG) and blood flow (BF), blood volume (BV), flow extract product (FEP), mean transit time (MTT), time to peak (TTP) and maximal intensity projection (MIP).  Result  The laboratory indicators and perfusion parameters of TC, TG, HDL, MTT, TTP were higher in group A, while BV, BF, MIP, FED were lower respectively (P < 0.05). There was a significant inverse correlation between the clinical grades and perfusion parameters(BV, BF, MIP) in hyperglycemic acute pancreatitis (r=-0.835、-0.753、-0.543、P < 0.05).  Conclusion  The third-generation dual-source low-dose CT perfusion is useful for evaluating severity of the microcirculation of the pancreas in patients with hyperglycemic acute pancreatitis, which is conducive to early clinical treatment and intervention.